Rectocele. Rectal prolapse. The same thing?
I often see these two terms used interchangeably, but they refer to two different conditions. The rectum refers to the lowest 12-15 centimetres of the large intestine (colon) and is located just above the anal canal, the junction of which is called the anorectal angle. The rectum is securely attached to the pelvis by ligaments and muscles that hold it in place. As with all pelvic organ prolapses, these muscles and ligaments can weaken for a variety of reasons resulting in a rectocele or rectal prolapse.
Rectocele
- A rectocele is when the rectum falls forward into the back or posterior part of the vagina. This can be felt as a lump inside the vagina and in the case of severe rectocele, the posterior wall of the vagina falls to or through the vaginal opening.
Rectal Prolapse
- A rectal prolapse is when the prolapsed tissue doesn’t fall forward into the vagina, but rather, it protrudes through the anal opening. In the early stages of rectal prolapse, the rectal tissue may protrude and retract depending on movement and activity (activities that increase intra-abdominal pressure increase the chance of protrusion, including heavy lifting, excessive coughing, straining with bowel movements, etc.). As the condition progresses, the rectum may begin to protrude more frequently or even permanently.
Signs and Symptoms
Rectocele
- Bulge in the vagina
- Heaviness, pressure, feeling of rectal fullness
- Difficulty emptying bowels
- Feeling of incomplete evacuation
- Need to remove stool manually
- Need to insert thumb and push on the back wall of the vagina to assist in evacuating stool
Rectal Prolapse
- Pain during bowel movements
- Mucus or blood discharge from the protruding tissue
- Fecal/anal incontinence
- Loss of urge to defecate
- Awareness of something protruding from anus upon wiping
Causes of Rectocele and Rectal Prolapse
- Chronically increased intra-abdominal pressure
- Chronic coughing
- Chronic constipation/diarrhea
- Pregnancy/delivery
- Repeated heavy lifting
- Genetics
Treatment
Rectocele
- Pelvic floor muscle training https://torontopessaryclinic.com/the-pelvic-floor-what-is-it/.
- Education on bladder and bowel health
- Education on evacuation techniques https://torontopessaryclinic.com/stool-evacuation/
- Pessary https://torontopessaryclinic.com/what-is-a-pessary/
- Surgery
Rectal Prolapse
- Education on bladder and bowel health
- Education on evacuation techniques
- Surgery
If you suspect you have either a rectocele or rectal prolapse, we would be happy to discuss healthy bladder and bowel habits as well as evacuation techniques to avoid further strain on the pelvic floor muscles and ligaments and help you achieve improved emptying. If you have a rectocele, we can also fit a pessary for you to help manage your symptoms. Give us a call today!
The information in this blog is provided as an information resource only and should not be used as a substitute for seeking personalized direction from your overseeing physician. Please consult your healthcare team before making any decisions about your pessary treatment plan, which is unique to you and your overall health. Toronto Pessary Clinic expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this blog.